In DepthNeglected Diseases

Parasitic worm may trigger mystery nodding syndrome

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Science  17 Feb 2017:
Vol. 355, Issue 6326, pp. 678
DOI: 10.1126/science.355.6326.678

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  • RE: Onchocerca volvulus: culprit or accomplice?

    As G. Vogel reflects in her article, there is an ongoing debate on the possible connection between the nodding syndrome, a kind of epilepsy found in certain African regions, and onchocerciasis, a parasitic worm infection caused by Onchocerca volvulus (1). Among the factors that can cause the syndrome, Wolbachia, a worm's bacterial endosimbiont, should not be forgotten (2). Wolbachia infections are considered one of the greatest pandemics ever (3). Wolbachia have the potential to mediate diseases ranging from dengue fever and Chikungunya to malaria and lymphatic filariasis (3). Research on these exclusive bacteria from certain arthropods and filarial worms is shedding light on relevant aspects such as the reproduction of filariae, the inflammatory disease pathogenesis, and the immunomodulation of the vertebrate host, and has led to the consideration of antibiotic therapy as a novel method of treatment (4).
    A trend towards a positive association between the cerebral pathology and a positive skin PCR (polymerase chain reaction) for O. volvulus has been found in patients in Tanzania (5). However, intriguingly, contrary to skin PCR results, PCR of CSF (cerebrospinal fluid) was negative in all patients (5). It might be that Onchocerca is not the direct culprit of the nodding symptom but Wolbachia's accomplice, enabling the presence of the bacteria, potential trigger of that syndrome, in patients. In fact, a proposed phase II trial of the antibiotic doxycycline w...

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    Competing Interests: None declared.